MEDICARE: KATHERINE R BUCHANAN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	10000456A	IN

General Provider Information

NPI Number	:	1558467480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE R BUCHANAN PA-C

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8820 S MERIDIAN ST
Second Line	:	STE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-6058
Country	:	US
Telephone Number	:	317-865-6750
Fax Number	:	317-865-6759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	03/16/2021

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